Total intracorporeal robot-assisted laparoscopic Mainz II rectosigmoid pouch

Abstract

Objective To report the surgical techniques and results of robot-assisted laparoscopic radical cystectomy (RRC) with bilateral pelvic lymphadenectomy and the Sigma rectum pouch (Mainz II) performed with an intracorporeal robotic technique at our center. Methods There was 1 female 63 years old with organ confined, muscle invasive transitional cell carcinoma of the bladder who underwent completely robot assisted surgery. The procedure included pelvic lymph node dissection, radical cystectomy with uterus and tubal structures, creation of the rectal sigmoid pouch and bilateral stented antireflux implantation of the ureters into the pouch. A 20 cm segment of the sigmoid was isolated. The posterior wall of the pouch were anastomosed side-to-side. And a nipple was formed by suturing the mucosa over the ureters to accomplish an antireflux mechanism. The F8 mono-pigtail ureteral stents were led out through the rectum, and a F26 Foley catheter was placed transanally for pouch drainage. Finally the anterior wall of the pouch was closed two layers. Results Operating time was 470 min and blood loss was 600 ml. The rectal tube was removal on the 9d postoperative day and the ureteral stents were removed 11 d and 12 d postoperatively. No intraoperative or postoperative complications were observed. The patients were followed up for 2 years, urinating 4-5 times per day and 1-2 times at night, CO2CP is 17.8mmol/L. The patient showed no upper urinary occlusion, reflux or urine incontinence. Conclusion To our knowledge, this is the first robotic radical cystectomy with intracorporeal continent urinary diversion (Mainz Ⅱ), RRC with the Mainz Pouch Ⅱ may become a simple and effective alternative surgical method for treating select patients with localized muscle invasive bladder cancer. Key words: Bladder cancer; Robot-assisted laparoscopic surgery; Radical cystectomy; Controlled urinary diversion